BILL ANALYSIS Ó SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT Senator Jerry Hill, Chair 2015 - 2016 Regular Bill No: AB 2193 Hearing Date: June 27, 2016 ----------------------------------------------------------------- |Author: |Salas | |----------+------------------------------------------------------| |Version: |April 5, 2016 | ----------------------------------------------------------------- ---------------------------------------------------------------- |Urgency: |No |Fiscal: |Yes | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Sarah Mason | |: | | ----------------------------------------------------------------- Subject: California Board of Podiatric Medicine: Physician Assistant Board: extension SUMMARY: Extends the operation of the Board of Podiatric Medicine (BPM), the operation of the Physician Assistant Board (PAB), and the PAB's authority to appoint an executive officer from January 1, 2017 to January 1, 2021. Existing law: 1)Establishes the BPM within the jurisdiction of the Medical Board of California (MBC) until January 1, 2017. Provides that the repeal of the enacting statute renders the BPM subject to review by the appropriate policy committees of the Legislature. (Business and Professions Code (BPC) § 2460) 2)Establishes the PAB within the jurisdiction of the MBC until January 1, 2017. Provides that the repeal of the enacting statute renders the PAB subject to review by the appropriate policy committees of the Legislature. (BPC § 3504) 3)Requires, until January 1, 2017, and except as provided in BPC §§ 159.5 and 2020, the PAB to employ within the limits of the Physician Assistant Fund all personnel necessary to carry out the provisions of the Physician Assistant Practice Act, including an executive officer who shall be exempt from civil service. Requires the MBC and PAB to make all necessary expenditures to carry out the provisions of the Physician AB 2193 (Salas) Page 2 of ? Assistant Practice Act from the Physician Assistant Fund. (BPC § 3512) This bill: 1)Extends the sunset dates for the BPM and the PAB until January 1, 2021. 2)Extends the PAB's authority to appoint an executive officer until January 1, 2021. FISCAL EFFECT: This bill is keyed "fiscal" by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated April 20, 2016, this bill will result in costs of approximately $1.5 million per year for four additional calendar years to continue the operation of the BPM and costs of approximately $1.6 million per year for four additional calendar years to continue the operation of the PAB. COMMENTS: 1. Purpose. This bill is sponsored by the Author , and is one of five "sunset bills" the Author is sponsoring this Session. According to the Author, "because the boards are set to sunset in 2017, the date needs to be extended to ensure the continued regulation of the professions." 2. Oversight Hearings and Sunset Review of Licensing Boards and Programs. Beginning in 2015, the Senate Business and Professions Committee and the Assembly Business and Professions Committee (Committees) conducted joint oversight hearings to review 12 regulatory entities: Department of Consumer Affairs (DCA), Acupuncture Board, Board of Behavioral Sciences, California Massage Therapy Association, Court Reporters Board, Board of Pharmacy, PAB, BPM, Bureau for Private Postsecondary Education (BPPE), Board of Psychology, Bureau of Real Estate, Bureau of Real Estate AB 2193 (Salas) Page 3 of ? Appraisers and Veterinary Medical Board. The Committees conducted two hearings in March. This bill and the accompanying sunset bills are intended to implement legislative changes as recommended by staff of the Committees and which are reflected in the Background Papers prepared by Committee staff for each agency and program reviewed this year. 3. Background on BPM. BPM is a licensing board under the DCA. BPM licenses and regulates doctors of podiatric medicine (DPMs). In the Medical Practice Act, a license to practice podiatric medicine is called a "certificate," but it is indistinguishable from other professional licenses. It is a misdemeanor to practice podiatric medicine or use the title DPM, podiatrist, or similar designation without a license. The Practice Act defines "podiatric medicine" as all medical treatment of the foot, ankle, and tendons that insert into the foot, including diagnosis, surgery, and the nonsurgical treatment of the muscles and tendons of the leg governing the functions of the foot. Therefore, a DPM's scope of practice is similar to that of a physician and surgeon who specializes in the foot and ankle. However, unlike a physician and surgeon, whose scope is only limited by the licensee's own area of competence, a DPM's scope is limited by the license to the foot and ankle. Historically, the BPM was a committee within the Medical Board of California (MBC). Currently, however, the BPM functions as an independent board, similar to other licensing boards under the DCA. Still, the Practice Act continues to describe the BPM as "within the jurisdiction of" the MBC. As a result, the BPM makes recommendations for DPM licensure to the MBC, while the MBC officially issues the licenses, but defers completely to the judgment of BPM. The BPM licenses approximately 2,000 DPMs. On average, it issues 106 licenses each year and renews on average 1,106 licenses each year. As a special fund agency, the BPM receives no general funds. Instead, it relies on fees set by statute and collected from licensing and renewal. The purpose of the BPM's licensing program is to protect the public and consumers by ensuring minimum competency in practitioners. Applicants for a DPM license must graduate from a college of podiatric medicine that has been approved by the BPM, pass Part I, II and III of AB 2193 (Salas) Page 4 of ? the national exam and successfully complete two years of postgraduate training. 4. Review of the BPM - Issues Identified and Recommended Changes. Committee staff identified 11 issues pertaining to BBS and provided background information concerning each issue. Recommendations were made by Committee staff regarding the particular issue areas which needed to be addressed. Only one of the identified issues for BPM required a statutory change. a) Issue : Continued Regulation of the Profession by BPM. Background : The health, safety and welfare of consumers are protected by the presence of a strong licensing and regulatory board with oversight over DPMs. The BPM has shown a commitment to its mission and a willingness to work with the legislature to improve consumer protection. Therefore, the BPM should be continued with a 4-year extension of its sunset date so that the Legislature may once again review whether the issues and recommendations in this Background Paper have been addressed. Recommendation and Proposed Statutory Change : The committee recommends that DPMs continue to be regulated by the current the BPM members in order to protect the interests of the public and be reviewed again in four years. This bill extends the operation of BPM for four years. 5. Background on PAB. PAB is also a licensing board under DCA. PAB licenses and regulates physician assistants (PAs). PAs provide health care services under the supervision of a physician and surgeon. PA functions include performing diagnostic, therapeutic, preventive, and health maintenance services. Currently, the PAB has over 10,000 licensed PAs. Historically, the PAB was a committee within the MBC, however, the current PAB is an independent board with regulatory authority to enforce the Physician Assistant Practice Act. The PAB still utilizes many of the MBC's services, including enforcement, information technology, and fund management via a contract with MBC. The PAB's mandates include: AB 2193 (Salas) Page 5 of ? Approval of the educational and training requirements of PAs Licensing of PAs. Promoting the health and safety of California health care consumers by enhancing the competence of PAs. Coordinating investigation and disciplinary processes Providing information and education regarding the PAB or PA professionals to California consumers. Managing a diversion/monitoring program for PAs with alcohol/substance abuse problems. 1. Review of PAB - Issues Identified and Recommended Changes. Committee staff identified 10 issues pertaining to PAB and provided background information concerning each issue. Recommendations were made by Committee staff regarding the particular issue areas which needed to be addressed. Only one of the identified issues for PAB required a statutory change. a) Issue : Continued Regulation of the Profession. Background : The health, safety and welfare of consumers are protected by the presence of a strong licensing and regulatory board with oversight over PAs. The PAB has shown a commitment to improve its overall efficiency and effectiveness and has worked cooperatively with the Legislature and the Committees to bring about necessary changes. Therefore, the PAB should be continued with a 4-year extension of its sunset date so that the Legislature may once again review whether the issues and recommendations in this Background Paper have been addressed. Recommendation and Proposed Statutory Change : The licensing and regulation of PAs should continue to be regulated by the current members of the PAB in order to protect the interests of the public and be reviewed once again in four years. This bill extends the operation of PAB and PAB's authority to appoint an EO for four years. AB 2193 (Salas) Page 6 of ? 2. Related Legislation This Year. SB 1039 (Hill), among other changes to the operations and fee structure of a number of boards under DCA, gives BPM their own chapter in the Business and Professions Code and formally separates it from the Medical Board, reflecting operational realities. ( Status: The bill is currently pending in the Assembly Committee on Business and Professions.) SUPPORT AND OPPOSITION: Support: California Academy of Physician Assistants Opposition: None on file as of June 21, 2016. -- END --